Os mecanismos de governança do saneamento básico no Brasil : um estudo de direito administrativo sob a perspectiva da economia dos custos de transação

O serviço público de saneamento básico tem relevância amplamente reconhecida. Apesar disso, ainda são verificados no Brasil elevados índices de déficit ou de atendimento precário, com situações distintas nas diversas regiões do país. Nesse sentido, o objetivo desta dissertação é (i) apresentar, a partir da perspectiva interdisciplinar da Economia dos Custos de Transação, uma compreensão do serviço público de saneamento básico no Brasil, atualmente regulamentado pela Lei nº 11.445/2007, (ii) avaliar a eficiência do modo de governança majoritariamente utilizado e, (iii) eventualmente, propor desenhos alternativos para a organização da prestação que sejam economicamente superiores em temos de redução de custos de transação para a realização de investimentos necessários ao cumprimento dos objetivos fundamentais definidos no art. 2º, da Lei nº 11.445/2007. A pesquisa adotou como estratégia metodológica a utilização de uma abordagem interdisciplinar de direito, economia e organizações, nos termos da análise econômica da nova economia institucional. A partir o estudo do ambiente institucional básico, com apoio no referencial teórico, observou-se que o mecanismo de governança predominantemente utilizado no serviço público de saneamento básico no Brasil, isto é, delegações a Companhias Estaduais de Saneamento por meio de contratos de longo-prazo (contratos de programa), não favorece a realização de investimentos em ativos específicos (infraestrutura) necessários à prestação e cumprimentos de metas da política. Foi também constatado que existem alternativas de governança viáveis ao desenho predominante, embora a utilização de formas alternativas provavelmente não possua execução viável pelo simples transplante de normas, isto é, pela via formal. A modificação da forma de governança predominante no saneamento básico no Brasil, com a superação do baixo desempenho verificado (low-level equilíbrium), não é possível de ser realizada sem custos. Nesse sentido, é necessário superar os custos para o rompimento do path dependence provocado pelo hold up realizado pelas Companhias Estaduais de Saneamento Básico sobre os titulares do serviço público (municípios), bem como os custos para o rompimento do path dependence no direito administrativo brasileiro, o qual restringe o desenvolvimento de uma teoria jurídica da regulação apta a viabilizar a construção de uma governança regulatória adequada à redução dos custos de transação, de modo a tornar viáveis investimentos em ativos de infraestruturas com elevado grau de especificidade.

Direitos sociais e Bolsa Família na ordem constitucional brasileira: virtudes e fragilidades de um "meta-direito"

Apesar de uma Constituição carregada de direitos sociais visando à transformação da sociedade brasileira, foi somente a partir de 2003 que o país ganhou destaque internacional nas ações de combate à pobreza e desigualdade, tornando-se uma referência. O grande protagonista teria sido o Programa Bolsa Família (PBF), um programa de transferência de renda condicionada que, combinado aos direitos sociais, teria permitido o alívio imediato de situações de extrema pobreza, mas também o desenvolvimento do capital humano atingindo resultados positivos multidimensionais nos seus mais de 10 anos de existência. Tal processo iniciou um debate acerca da necessidade de institucionalizar o programa como uma política de Estado, que para alguns interlocutores significaria transformar o PBF em um “direito” aos moldes dos direitos sociais, impondo uma obrigação aos governos futuros. Diante disso, este trabalho busca identificar, do ponto de vista jurídico e comparado aos direitos sociais, quais as vantagens e desvantagens do PBF na sua configuração atual. Compondo o movimento que busca compreender o papel do direito nas políticas públicas, adotando uma abordagem intra e interdisciplinar, e uma perspectiva funcional; a reflexão é alicerçada em três “eixos”: a cidadania, a judicialização e a vinculação orçamentária. Esse “tripé” foi escolhido em função da estrutura constitucional acerca dos direitos sociais, que em uma leitura funcional representam uma obrigação de fazer ao Estado para a concretização de uma noção de cidadania abrangente; uma dotação orçamentária vinculativa, garantido que parte da receita será destinada a ações de cumprimento dessas obrigações; e os instrumentos para adjudicação, permitindo a exigência dessas ações estatais pelos cidadãos. Assim, este trabalho não buscar descrever ou tentar prescrever a natureza ou alcance das obrigações que a transformação do PBF em direito geraria ao Estado; mas sim refletir sobre as vantagens e desvantagens dessa eventual mudança do programa diante das características estruturais do país, do modelo de sociedade abstratamente desenhado na lei maior e de nossa cultura jurídica acerca dos direitos sociais.

Síndrome metabólica e risco cardiovascular na pós- menopausa: avaliação por diferentes critérios diagnósticos e influência de fatores sócio-econômicos

The metabolic syndrome (MetS) involves a group of risk factors and is associated with a significantly higher risk of developing cardiovascular diseases (CVD) and type 2 diabetes. Recent studies have shown the importance of preventing CVD through early diagnosis and treatment of patients with MetS. The objective of our study was to determine the prevalence of MetS by different diagnostic criteria in postmenopausal women and analyze the influence of socioeconomic factors on cardiovascular risk in this sample of the population. A cross-sectional study involving 127 postmenopausal women (45 to 64 years) from Natal and Mossoró, Brazil. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. The experimental protocol consisted of applying structured interview, clinical examination and implementation of dosages blood. The diagnosis of MetS was based on NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) and IDF (International Diabetes Federation) criteria. The research was accomplished with the participation of an interdisciplinary team in their several phases. The result of the sample studied had mean age of 53.9 ± 4.6 years and per capita income of 54.5 dollars. The prevalence of MetS, according to NCEP-ATP III and IDF criteria, was 52.8% and 61.4$, respectively. The agreement rate between NCEP-ATP III and IDF criteria was 81.9%, with a kappa value of 0.63 (CI 95%, 0.49-0.76), indicating good agreement between the two definitions. The most prevalent cardiovascular risk factor was HDL < 50 mg/dl, observed in 96.1% of the women analyzed, followed by increased waist circumference (≥ 80 cm) in 78.0%, elevated blood pressure in 51.2%, triglycerides ≥ 150 mg/dl in 40.9% and glycemia ≥ 100 mg/dl in 37.0% of the women. The occurrence of MetS was significantly associated with schooling and body mass index (BMI). High blood pressure was significantly associated with low family income, low schooling and weight gain. There was no significant association between the intensity of climacteric symptomatology and the occurrence of MetS. The conclusions of the research were that MetS and its individual components show a high prevalence in postmenopausal Brazilian women, and significant associations with weight gain and low socioeconomic indicators. The data point to the need for an interdisciplinary approach at the basic health care level, directed toward the early identification of risk factors and the promotion of cardiovascular health of climacteric women.

Determinantes envolvidos na resposta imune celular humana à infecção por Leishmania infantum chagasi

Visceral leishmaniasis (VL) is a disease caused by protozoa of the Leishmania donovani complex, whose infection has clinical spectrum ranging from asymptomatic infection to active disease characterized by fever, cachexia, hepatosplenomegaly, and immunosuppression. The healing or protective immunity require an antigen-specific type 1. The Montenegro skin test (DTH) has been interpreted as a marker of protective immunity. However, there is no known correlation between the DTH response to type 1 and DTH and immunity of type 1 are maintained in the long term. Thus, a longitudinal study of 8 years, nested in a cohort family held in Brazil, documented the status of DTH and cytokine production by peripheral blood mononuclear cells in response to antigen-specific stimulation. This study was the interdisciplinary approach of physicians, biochemists, nutritionists, veterinary medicine, biology and statistics. The results show that 46.2% of subjects were analyzed DTH positive at baseline. The prevalence of positive and DTH induration size increased with age (p = 0.0021). 15.7% of individuals positive DTH "retro-converted" the negative and 50.4% (64) of individuals negative DTH became positive. The size of DTH induration was correlated significantly with the antigen-induced production of IFN-γ (r = 0.6186, p = 0.0001). IL-6 was secreted at higher levels in peripheral blood mononuclear cells of individuals who "retro-converted" DTH positive to negative than individuals who remained stable DTH status (p = 0.005). Thus, IFN-γ produced by peripheral blood mononuclear cells, may be a surrogate marker for protective immunity instead of the DTH response. In addition, differences in innate immune response may determine whether individuals maintain or eliminate the infection by Leishmania infantum chagasi in asymptomatic patients

Qualidade de vida, funcionalidade e morbidade referida : avaliação em idosos na atenção básica de saúde

Demographic and epidemiological transformations have led to an increase in elderly populations in the world, and chronic diseases become the main health problem in this population, with consequences for the independence and autonomy, and interfering in the lifestyle and daily activities, and may decrease the welfare and quality of life. So, there is an urgent need for multidisciplinary research on the quality of life, understood as a multidimensional and subjective concept, as well as the associated factors, such as health habits, presence of chronic conditions and functional capacity. Thus, In qualitative terms, the Article 1 provides an assessment and perception of the elderly about their quality of life. Article 2, in turn, presents the results of more extensive quantitative research, which can be seen that age, presence of chronic diseases and depression were associated with the quality of life. Thus, we discuss the need for action was planning and health strategies, with interdisciplinary approach, considering the environmental context and reality of family elders, promoting quality in the process of aging

Comunicação e cidades: interlocuções para uma interdisciplinaridade nas ciências sociais

This thesis aims at producing knowledge by putting together various theories and empirical analyses. In other words, from an interdisciplinary approach within the Social Sciences and having as background Communication and the City, this work presents, in each chapter, a disciplinary field Literature, Architecture, History and Geography , with which they relate, exhibits its theoretical pillars and performs a case study as a factual and critical contribution, considering the urban spaces of Rio de Janeiro, Brasília, São Paulo and Natal. By so doing, the thesis covers the period from the end of the XIX to the beginning of the XXI Century. Overall, the thesis is an interconnected and dialogic set that points to a cosmology of plural knowledge

Literatura de monteiro lobato no ensino de ciências

Advocating education as a humanizing task, the humanizing function of literature and the importance of scientific education, this paper proposes linking Science and Literature in Science Teaching using two specific books of Monteiro Lobato in the final series of elementary school level. Adopting the action research methodology, an interdisciplinary approach, we used the books A Reforma da Natureza and Serões de Dona Benta in two classes (8th and 9th) at Escola Estadual Professor José Mamede, located in the town of Tibau do Sul, Rio Grande do Norte. The readings were performed in Portuguese Language s course and the scientific content were discussed in Science´s classrooms. The book A Reforma da Natureza permitted to approach issues related to the environment, while the use of Serões de Dona Benta showed particularly its effectiveness in questioning the concepts of matter, mass, weight and some questions about the Nature of Science (NOS). In general, the analysis of results shows that the readings of these two books permitted interaction and dialogicity in the classroom, as well as indicates the potential of these books in contextualing and questioning the scientific content contained in it. We advise, however, the need for the science teacher be aware of the conceptual mistakes present in literary works, avoiding erroneous learning and reinforcement of alternative conceptions

A migração do cuidado em saúde: do hospital para o domicílio

This study is an analysis of opportunities and challenges of health assistance migration from hospitals to home care from the approach of the Domiciliary Internment Program (PID) in Natal / RN. The research aims to identify the ways that the multidisciplinary team act and know the stories of these professionals about the situation experienced in the transition between the instituting and instituted on home care modalities. PID has as a prior focus the elderly person in stable medical conditions, not to replace the hospital care, but to offer a therapeutic support turned to the exercise of their autonomy and coexistence with the situation of diseases. The home in their internal coexistence rules preserves own customs. As the hospital care migrates to the home care, it happens in the confrontation and rationality negotiation and becomes something new, that is going to be directed by an instituting dimension. In the view of New History, that suggests an interdisciplinary approach and interprets the problems on its time and from the technique of thematic oral history, it can be seen that working in interdisciplinary team is able to incorporate new values in the way of healthcare assistance, it longs for maintaining the maximum functional capacity of patients, it presents results as the prevention of diseases, costs reduction in connection with the Hospital Service, empowers and expands the possibilities for the patient recovery by aligning with the daily life and the opportunity of the patient being assisted by a multiprofessional team, interacting on the concrete reality. Therefore, PID is in line with the contemporary demands and as an instrument to be considered in the review of a wider concept of the health-disease process

Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Reflexões e contribuições para o ensino de gravitação clássica no nível médio

The subject of Classic Gravitation is part of the actual curriculum for High School in Brazil, and it is taught in the first year of that education level. This master thesis presents a research regarding the subject Classic Gravitation in High School. This research was based in two complementary guidelines of research and action. The first guideline was the analysis of 21 didactic books of physics which are the more frequently used in High School, in the city of Natal/RN. The second guideline, worked after being verified the most common deficiencies presents in the didactic books, was the elaboration, followed by a practical application, of a course suggesting how to approach that subject in the classroom. The Parâmetros Curriculares Nacionais para o Ensino Médio (National Curricular Parameters for High School PCNEM) defend that Classic Gravitation is very important in the student s formation and that its study helps the comprehension of many nature s phenomena. Because of this vision of that subject by the PCNEM, the 21 analyzed books were separated in two groups: the first one, containing 10 books, was edited before the spreading of PCNEM, and the second, with 11 books, after that spreading. Whatever the group to which the didactic books belonged, the great majority of them let that subject in a second plan; two of them even suggesting, in the teacher s orientations, that the subject Gravitation can be suppressed in case of insufficient time . These analyses points that the PCNEM had produced no changes in the conception of the authors that wrote books regarding that subject. To analyze the didactic books, we elaborated a script which was used as an analysis tool, in which we put in evidence the relative importance of the historic and philosophic contextualization of the subject, the quotidian experience of the students and the interdisciplinary approach, among other aspects. It became evident that the didactic books give very little emphasis to historic aspects of the knowledge construction, to the relations with the day-by-day questions and to the interdisciplinary character of the subject Gravitation. It calls attention the non concordance among the authors opinions regarding the necessary previous knowledge or prerequisites the students should fulfill in order to begin to study Gravitation. The course we elaborated was given to a group of teachers as well as to students. In those courses we treated theoretical and practical aspects and emphasized historical questions and the ones which are related to people s daily life. The course for teachers was realized as an extra-mural activity of the UFRN and was given by the author of this thesis at the Escola Estadual Francisco Ivo Cavalcanti (a state public school in Natal/RN). There were 23 teachers present, from several public schools and several fields of knowledge. The thesis supervisor and the master degree s colleagues of the author acted as collaborators , reporting the participants opinions and speeches. The course to the students, on the other hand, had the participation of 300 regular students who belonged to 6 different 1st year classes of the High School Escola Marista de Natal (RN), in which the author acts as a physics teacher. The student s course was realized as part of the regular curriculum activities, in which three classes stood under the responsibility of the author and other three classes in charge of another Marista s teacher, who participated as a collaborator . The teacher s course as well as the students one were given in two stages, with five hours each. The first stage was divided in two moments, the first one focused on the survey of the spontaneous conceptions about gravitation, in which we worked basically with experiments of free throwing and pendulum, and the second one focused in theoretical presentations and quarrels about universe s models. In the second stage of the course we improved the study of Kepler s laws and the Newton s Universal Gravitation law, and we used as motivating tools some practices involving the construction of the solar system in scale. As instruments for evaluating both courses we used questionnaires and reported the speeches with participants opinions, beyond usual written evaluations in the course for the students. The teachers who participated in the course showed very good wills in realizing interdisciplinary practices; nevertheless, according their own speeches, they frequently came across the difficulty of how to do . From the experience we had in both courses, we conclude that the approach we propose hear to the teaching of the subject Classic Gravitation , supported on the tripod theory, practice and historical and philosophical aspects, is viable and effective. One hopes that this research may contribute in the formation of a opinion, among the teachers, concerning how to approach the subject of Classic Gravitation, and may offer suggestions in order those who want to apply that approach may develop classroom practices aiming to improve the teaching of that subject, which has a singular importance in the formation of High School students

O ensino de óptica no nível fundamental: uma proposta de ensino aprendizagem contextualizada para a oitava série

This dissertation presents the investigation and possible interference in the current teaching of physics, specially of optics, in the eighth grade/ ninth year / fourth cycle of junior high school. The context of the current science teaching is also presented. Besides, the following aspects are discussed: the preparation of the eighth grade teachers, their professional needs, the pedagogical practices and the theoreticmethodological difficulties faced by them. Another important issue in Science Teaching, which is also discussed in this dissertation, is the need for an efficient scientific literacy so that the citizen may express value judgment about Science and Technology issues. The data about the context were gathered from questionaires answered by the teachers. In value of this information, lesson plans were elaborated and implemented. The goal was to point out alternatives for the development of a teaching-learning evaluation which would be both pleasant for the teachers in relation to the implemented methodology, end meaningful for the students by adding elements such as: interdisciplinary approach, contextualization and preparation by competences. Furthermore it was carried out a deeper analysis of the Brazilian curriculum references (LDB, DCN, PCN, RCB) and content aspects (concepts, procedures e attitudes) to be executed by that branch of human knowledge, aiming at a really Contextualized Science Teaching, qualified and pleasant for the eighth grade level. It is also presented in this paper the profile or the Professional which teach this level at state public schools in Russas, state of Ceará, Vale do Jaguaribe Region. The efficacy of the lesson plans were also analysed by using evaluation procedures with the eighth grade students of the following schools: CAIC Senador Carlos Jereissati and EEF Manuel Matoso Filho, from which the concepts acquired during the implementation of the classes became evident in the students

Alterações do ciclo sono-vigília moduladas por Dopamina e suas consequências Mnemônicas

Neuroscience is on a rise of discoveries. Its wide interdisciplinary approach facilitates a more complex understanding of the brain, covering various areas in depth. However, many phenomena that fascinate human kind are far from being fully elucidated, such as the formation of memories and sleep. In this study we investigated the role of the dopaminergic system in the process of memory consolidation and modulation of the phases of sleep-wake cycle. We used two groups of animals: wildtype mice and hiperdopaminergic mice, heterozygous for the gene encoding the dopamine transporter protein. We observed in wild-type mice that the partial blockade of the D2 dopamine receptor by the drug haloperidol caused deficits in memory consolidation for object recognition, as well as a significant reduction in the duration of rapid eye movement sleep (REM). We also found a mnemonic deficit without pharmacological intervention in hiperdopaminergic animals; this deficit was reversed with haloperidol. The results suggest that dopamine plays a key role in memory consolidation for object recognition. The data also support a functional relationship between the dopaminergic system and the modulation of REM sleep

A doença como ponto de mutação :os processos de significação em mulheres portadores de lúpus eritematoso sistêmico

Systemic lupus erythematous (SLE) is a chronic and auto-immune disease that can affect several systems of one´s body, including the nervous system, causing several clinical evidences, which can put in risk the person´s life. Although the illness could manifest itself at any age or sex, studies indicate higher incidence among women. Its etiology points to the combination of genetic, hormonal and environmental factors. Due to the disease´s complexity, it is evident that it affects all the person´s life as a whole and not only its organic dimension. It is believed that the signification attributed to all the process of sickening influences its treatment, as well as the person´s capacity to cope with the difficulties and implicit profits involved in the process.In this study, eight women who were affected by SLE were interviewed, with the aim of examining carefully the processes of signification as well as the generation of meanings which permeate these women´s sickening processes. The analysis of their speeches evidences distinct forms of giving meaning to the process, regardless of the time of the diagnosis. The fact that the disease is incurable was shocking to all the participants, and it demanded changes in their lives, in order to detain a relative control of their condition. The majority of the participants were able to deal with these modifications, since strategies have been created to face the difficulties and thus to preserve their social life, without damaging their health. However, some of the participants did not obtain strenght to cope with the disease, eventually developing a depressive state. It is observed that not only SLE has innumerable ways of manifestation, but the experience of the illness is very subjective and dynamic. There are also several ways of expressing this experience, according to the implications in the social, cultural and economic context where the participants are inserted. This ratifies the necessity of a interdisciplinary approach to embrace SLE complexity. (310 words, 1.610 characters)

O papel da Ortodontia como auxiliar na estética labial

A busca pela excelência na estética facial tem sido uma realidade nos consultórios dos profissionais de saúde. Dentre os aspectos procurados pelos pacientes, destaca-se o aumento do contorno dos lábios, cada vez mais realizado e pesquisado por dermatologistas e cirurgiões-plásticos. Embora bons resultados sejam alcançados com os mais diversos procedimentos para preenchimento labial, a literatura mostra diversas complicações e efeitos colaterais. Este artigo demonstra, por meio de 2 casos clínicos, como a Ortodontia pode representar uma excelente ferramenta para auxiliar no aumento do contorno dos lábios, tornando a abordagem multidisciplinar uma estratégia mais efetiva na conquista de bons resultados clínicos

O método psicanalítico e a semiótica de Peirce: a semiose da prática psicanalítica

Pós-graduação em Filosofia - FFC